scholarly journals Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster‐randomised study in rural Tanzania

2019 ◽  
Vol 24 (5) ◽  
pp. 636-646 ◽  
Author(s):  
Elysia Larson ◽  
Anna D. Gage ◽  
Godfrey M. Mbaruku ◽  
Redempta Mbatia ◽  
Sebastien Haneuse ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
System Quality ◽  
Improvement Project ◽  
Randomised Study ◽  
Cluster Randomised ◽  
Rural Tanzania ◽  
Maternal And Newborn ◽  
Health System Quality

scholarly journals Using the WHO Safe Childbirth Checklist to Improve Essential Care Delivery as Part of the District -Wide Maternal and Newborn Health Quality Improvement Initiative, a Time Series Study

2020 ◽  
Author(s):  
Befikadu Bitewulign ◽  
Dereje Abdissa ◽  
Zewdie Mulissa ◽  
Abiyou Kiflie ◽  
Mehiret Abate ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Newborn Health ◽  
System Level ◽  
Maternal And Newborn Health ◽  
Safe Childbirth Checklist ◽  
Safe Childbirth ◽  
Over Time ◽  
Maternal And Newborn

Abstract Background: Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care. This study evaluates the effectiveness of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by "clinical bundle" adherence over-time.Methods: The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three "clinical bundles" were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births.A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime. Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.Findings: Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four regions. In Tigray region, adherence to “On Admission” bundle was increased monthly on average by B =1.39 (95% CI; 0.47 - 2.32; P<0.005).Similarly, adherence to the “Before Pushing” bundle in Southern Nations, Nationalities and People’s (SNNP) region increased monthly on average by B = 2.3 (95% CI; 0.89 - 3.74; P<0.005). Conclusion: Use of the WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.

scholarly journals Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania

2016 ◽  
Vol 27 (5) ◽  
pp. 738-749 ◽  
Author(s):  
Tara Tancred ◽  
Fatuma Manzi ◽  
Joanna Schellenberg ◽  
Tanya Marchant
Keyword(s):  
Quality Improvement ◽  
Newborn Health ◽  
Community Level ◽  
Quality Improvement Intervention ◽  
Maternal And Newborn Health ◽  
Health Seeking ◽  
Local Quality ◽  
Facilitators And Barriers ◽  
Using Data ◽  
Maternal And Newborn

A quality improvement intervention for maternal and newborn health was carried out in southern Tanzania at the community level. It sought to improve health-seeking behaviors and uptake of community-level maternal and newborn health practices. A process evaluation populated using data primarily from in-depth interviews and focus group discussions with the intervention’s implementers was undertaken in four villages receiving the intervention to evaluate the intervention’s implementation, uncover facilitators and barriers of quality improvement, and highlight contextual factors that might have influenced implementation. Performance implementation scores were used to rank the villages. Identifying higher- and lower-performing villages highlighted key facilitators and barriers of community-level quality improvement related to support from local leaders, motivation through use of local quality improvement data, and regular education around quality improvement and maternal and newborn health. These findings can be taken formatively in the design of similar interventions in the future.

scholarly journals Using the WHO safe childbirth checklist to improve essential care delivery as part of the district-wide maternal and newborn health quality improvement initiative, a time series study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Befikadu Bitewulign ◽  
Dereje Abdissa ◽  
Zewdie Mulissa ◽  
Abiyou Kiflie ◽  
Mehiret Abate ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Newborn Health ◽  
System Level ◽  
Maternal And Newborn Health ◽  
Safe Childbirth Checklist ◽  
Safe Childbirth ◽  
Over Time ◽  
Maternal And Newborn

Abstract Background Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care. This study evaluates the effect of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by “clinical bundle” adherence over-time. Methods The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three “clinical bundles” were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births. A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime. Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation. Findings Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four MNH collaborative. In Tankua Abergele collaborative (Tigray Region), the overall mean adherence to “On Admission” bundle was 86% with β = 1.39 (95% CI; 0.47–2.32; P <  0.005) on average monthly. Similarly, the overall mean adherence to the “Before Pushing” bundle in Dugna Fango collaborative; Southern Nations, Nationalities and People’s (SNNP) region was 80% with β = 2.3 (95% CI; 0.89–3.74; P <  0.005) on average monthly. Conclusion Using WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.

scholarly journals Impact of a maternal and newborn health results-based financing intervention (RBF4MNH) on stillbirth: a cross-sectional comparison in four districts in Malawi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Regina Makuluni ◽  
William Stones
Keyword(s):  
Risk Factors ◽  
Positive Impact ◽  
Newborn Health ◽  
Public Hospitals ◽  
Maternal And Newborn Health ◽  
Cross Sectional ◽  
Randomised Study ◽  
The Impact ◽  
Maternal And Newborn ◽  
Results Based Financing

Abstract Background Malawi implemented a Results Based Financing (RBF) model for Maternal and Newborn Health, “RBF4MNH” at public hospitals in four Districts, with the aim of improving health outcomes. We used this context to seek evidence for the impact of this intervention on rates of antepartum and intrapartum stillbirth, taking women’s risk factors into account. Methods We used maternity unit delivery registers at hospitals in four districts of Malawi to obtain information about stillbirths. We purposively selected two districts hosting the RBF4MNH intervention and two non-intervention districts for comparison. Data were extracted from the maternity registers and used to develop logistic regression models for variables associated with fresh and macerated stillbirth. Results We identified 67 stillbirths among 2772 deliveries representing 24.1 per 1000 live births of which 52% (n = 35) were fresh (intrapartum) stillbirths and 48% (n = 32) were macerated (antepartum) losses. Adjusted odds ratios (aOR) for fresh and macerated stillbirth at RBF versus non-RBF sites were 2.67 (95%CI 1.24 to 5.57, P = 0.01) and 7.27 (95%CI 2.74 to 19.25 P < 0.001) respectively. Among the risk factors examined, gestational age at delivery was significantly associated with increased odds of stillbirth. Conclusion The study did not identify a positive impact of this RBF model on the risk of fresh or macerated stillbirth. Within the scientific limitations of this non-randomised study using routinely collected health service data, the findings point to a need for rigorously designed and tested interventions to strengthen service delivery with a focus on the elements needed to ensure quality of intrapartum care, in order to reduce the burden of stillbirths.

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